CHAPTER 351-400

2. Which statement regarding nonalcoholic fatty liver disease (NAFLD) is NOT true?

A. Based on autopsy data, NAFLD is present in over 30% of obese children

B. African-American youth are at higher risk for NAFLD than white children

C. The clinical spectrum of NAFLD ranges from asymptomatic fatty liver alone to progressive fibrosis and cirrhosis

D. Gradual slow weight loss helps reverse NAFLD

E. Serum aminotransferase levels are not sensitive nor specific for NAFLD

4. A 12 yr old girl presented with nonspecific abdominal pain and hepatosplenomegaly and was found to have an ALT of 185 IU/L; total bilirubin, 2. 4 mg/dL; alkaline phosphatase, 640 IU/L; and an anti–smooth muscle antibody titer, 1: 80. Liver biopsy revealed a lymphoplasmacytic infiltrate of the portal tracts. She has been treated for 4 mo with prednisone without significant improvement. The next most appropriate diagnostic study would be:

A. Hepatitis C reverse transcriptase-polymerase chain reaction (RT/PCR) assay

B. Repeat liver biopsy

C. Abdominal ultrasound examination with Doppler interrogation

D. MR cholangiography

E. Slit lamp examination

34. A 17 yr old boy presents to the emergency department with difficulty breathing. He has had a sore throat and fever all week. Chest radiograph shows multiple nodules. Blood culture is most likely to grow:

A. Group A streptococcus

B. Peptostreptococcus

C. Staphylococcus aureus

D. Neisseria gonorrhoeae

E. Fusobacterium necrophorum

35. The typical development of a retropharyngeal abscess includes what stages?

A. Neck cellulitis → Boil → Deep abscess

B. Pharyngitis → Infected lymph node → Node cellulitis → Phlegmon → Abscess

C. Dental infection → Node cellulitis → Phlegmon → Abscess

D. Pneumonia → Mediastinitis → Abscess

E. A or B

48. A 4 mo old infant with mild stridor since the 1st week of life is diagnosed with laryngomalacia. He spits up often but has been growing well. What is the most appropriate treatment recommendation?

A. Initiate ranitidine or pantoprazole therapy

B. Prescribe nebulized albuterol twice daily

C. Prescribe low dose oral prednisolone daily

D. Schedule elective supraglottoplasty within the next month

52. A 6 mo old male infant with persistent wheezing is diagnosed with tracheomalacia by bronchoscopy. He has no history of atopy. What is the most appropriate treatment recommendation?

A. Prescribe daily salmeterol

B. Prescribe albuterol as needed during acute respiratory illness

C. Prescribe levoalbuterol as needed during acute respiratory illness

D. Prescribe ipratropium bromide as needed during acute respiratory illness

60. The treatment of pulmonary edema depends on the cause. Which treatment regimen is not indicated?

A. Cardiogenic pulmonary edema—Inotropes and systemic vasodilators

B. Pulmonary edema after fluid resuscitation for sepsis—Diuretics

C. High-altitude pulmonary edema—descent and supplemental oxygen

D. ARDS—Mechanical ventilation with high tidal volumes

E. Pneumonia—Nasal CPAP

61. A 2 yr old boy undergoing outpatient surgery for tonsillectomy vomits while recovering from general anesthesia in the postoperative recovery area. Within 1-2 min he develops tachypnea, chest retractions, and hypoxemia. Which of the following is the most likely explanation for these findings?

A. Acute blood loss from postoperative bleeding

B. Anesthetic reaction

C. Bacterial infection and toxin release

D. Acute pneumonitis

E. Atelectasis

71. In what scenario should testing for immunodeficiency be considered?

A. Toddler with 10 upper respiratory tract infections in 1 yr

B. 3 yr old with 2 documented pneumonias in 1 yr

C. 5 yr old with diagnosis of RLL pneumonia requiring hospitalization

D. Adolescent with Mycoplasma pneumonia by PCR who had mononucleosis and streptococcal pharyngitis earlier in the year

E. 4 yr old with 2nd pneumonia diagnosis; 1st occurred at age 6 mo

81. The classic triad of findings in pulmonary hemosiderosis includes:

A. Cough, iron deficiency anemia, infiltrates on chest radiograph

B. Clubbing, anemia of chronic disease, bronchiectasis on CT

C. Hypoxia, hemoptysis, multiple alveolar infiltrates on chest radiograph

D. Hemoptysis, iron deficiency anemia, multiple alveolar infiltrates on chest radiograph

E. Respiratory distress, anemia, multiple alveolar infiltrates on chest radiograph

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